title: The clinical course of late diagnosed fatal cases of A (H1N1) influenza in Poland.
abstract: BACKGROUND
  The most frequent complication of A (H1N1) influenza and the leading cause of death was pneumonia with a primary viral or mixed viral and bacterial etiology. 182 patients had died because of a pandemic influenza in Poland by 31st July 2010.
  
  
  METHODS
  A retrospective study of 6 fatal cases of pandemic influenza, aged 23-41, including 3 women, hospitalised between November 2009 and February 2011 in different Polish medical centres.
  
  
  RESULTS
  We present the clinical course of 6 late diagnosed cases of A (H1N1) influenza. All patients presented typical flu-like symptoms in the beginning. 4/6 patients had severe disease risk factors: pregnancy, arthritis, Wegener granulomatosis and obesity. All patients were seen by doctors, no one had received antiviral therapy, 4/5 were treated with antibiotics before they were hospitalized. One patient had nosocomial infection. Patients were admitted to the hospital on the 3rd to 8th day of the disease. They received oseltamivir treatment on the 4th to 9th day. All patients developed pneumonia complicated by acute respiratory distress syndrome. Death appeared between the 4th and 27th day after the onset of symptoms. Autopsies were performed in 5 cases and revealed haemorrhagic pneumonia in 2 patients.
  
  
  CONCLUSIONS
  Delayed diagnosis and antiviral treatment initiation has a significant impact on mortality in A (H1N1) influenza. During the influenza epidemic, patients presenting typical symptoms should always be suspected of having influenza. Antiviral treatment has to be initiated immediately, especially if there are risk factors of severe disease.
authors.affiliation: Department of Forensic Medicine, Wroclaw Medical University, Wroclaw, Poland. rorat.marta@gmail.com
authors.forename: Marta
authors.initials: M
authors.lastname: Rorat
authors.forename: Tomasz
authors.initials: T
authors.lastname: Jurek
authors.forename: Ernest
authors.initials: E
authors.lastname: Kuchar
authors.forename: Leszek
authors.initials: L
authors.lastname: Szenborn
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001168:Arthritis / Q000453:epidemiology; D002423:Cause of Death; D060085:Coinfection / Q000453:epidemiology*; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology; D057210:Delayed Diagnosis; D018450:Disease Progression; D005234:Fatty Liver / Q000453:epidemiology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D053139:Oseltamivir / Q000627:therapeutic use; D058873:Pandemics / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000453:epidemiology; D011044:Poland / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D012128:Respiratory Distress Syndrome / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir